Patients desiring a cosmetic smile improvement can present challenges to the dentist when treatment planning. An excessive display of gingiva due to a high lip line often complicates treatment planning and can compromise the final esthetic result when proper planning is not considered prior to finalizing the case. We often have to ask ourselves as we evaluate the patient, do we “lower the river” (increase tooth length incisally), “raise the bridge” (increase tooth length gingivally) or a combination of both approaches.We will address using the case presented a methodological approach to treatment planning and execution of a functional mock-up to fine tune the esthetics that will achieve the patient’s desires prior to finalization of the definitive restorations.

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The Aesthetic Smile: Diagnosis and Treatment Until recently, dentists' and the public's concept of dental aesthetics was necessarily limited to alterations of the teeth themselves. Dentists concerned themselves with changing the position, the shape and the color of the teeth -basically restoring missing units or enhancing those already present. For the most part the dentist was forced to accept the pre-existing relationship between the three components of the smile; the teeth, the gingival scaffold and the lips.

The Roll Technique in Soft Tissue Augmentation with ImplantsIn this surgical video, a modified roll technique is utilized for labial augmentation of an anterior implant at the time of uncovering. Incision design, de-epithelialization, tunnel flap on labial and suturing is described. Post-op results are included.

The Dual Zone Approach to Tooth Replacement in the Esthetic ZoneImprovements in implant designs have helped advance successful immediate anterior implant placement into fresh extraction sockets. Clinical techniques described in this presentation will enable practitioners to achieve predictable esthetic success using a method that limits the amount of buccal contour change of the extraction site ridge and potentially enhances the thickness of the peri-implant soft tissues coronal to the implant-abutment interface. This approach involves atraumatic tooth removal without flap elevation, and placing a bone graft into the residual gap around an immediate fresh-socket anterior implant with a screw-retained provisional restoration acting as a prosthetic socket seal device. Long term follow up and evidence from scientific literature to support this concept will be described.

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This lecture is intended for surgical beginners as well as experienced clinicians who want to update their surgical knowledge. These fundamentals are also very popular in the hands-on courses given by the Troeltzsch brothers.

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